Table1_Clinical utility of electrocardiographic voltage parameters for the diagnosis of hypertrophic cardiomyopathy.docx

BackgroundWhile electrocardiographic parameters of hypertensive left ventricular hypertrophy (H-LVH) are well known, limited data are available regarding hypertrophic cardiomyopathy (HCM). This study was to assess the diagnostic value of electrocardiographic voltage parameters in HCM.
MethodsIncluded patients with HCM treated between March 2015 and May 2023. Voltage parameters (S-L, Cornell, Cornell product, Lewis, Peguero, and modified Cornell voltages) and echocardiography were evaluated. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of electrocardiogram in HCM. The multiple linear regression was conducted to analyze the correlation between electrocardiogram indicators and cardiac diastolic function.
ResultsThe highest sensitivity for HCM was Peguero voltage (70.4%; 88.6% specificity). The Peguero voltage had high sensitivity in male (63.8%) and female patients (84.9%), those aged <65 years (71.6%) and ≥65 years (68.3%), with non-apical HCM (AHCM) (76.7%), obstructive HCM (82.1%), and non-obstructive HCM (66.9%). The sensitivity of the S-L voltage was high in AHCM (72.2%). The sensitivity for HCM reached 88.7% when the S-L and Peguero voltages were combined. The modified Cornell index had the highest area under the curve (0.88, 95% CI: 0.84–0.91), and its optimal cutoff value was 2.05 mV in males (77.6% sensitivity and 74% specificity) and 1.935 mV in females (90.6% sensitivity and 91.4% specificity). Peguero voltage (beta = 0.154, P = 0.034) and SD (beta = 0.223 P = 0.004) were independently correlated with E/e’, an index of left ventricular diastolic function.
ConclusionThe Peguero voltage had high sensitivity and specificity for detecting the presence of HCM. It was positively correlated with E/e’ in patients with HCM. For AHCM, the S-L voltage was more advantageous. Combining the S-L voltage with the Peguero voltage further improves the sensitivity for HCM and thus could be used to improve the screening of HCM in clinical practice. The SD and modified Cornell voltage also had good diagnostic performance, especially in females.

背景 尽管高血压性左心室肥厚（Hypertensive Left Ventricular Hypertrophy, H-LVH）的心电图参数已为学界广泛熟知，但针对肥厚型心肌病（Hypertrophic Cardiomyopathy, HCM）的相关研究数据仍相对匮乏。本研究旨在评估心电图电压参数对肥厚型心肌病（HCM）的诊断价值。
方法 本研究纳入2015年3月至2023年5月期间收治的肥厚型心肌病（HCM）患者，对心电图电压参数（包括S-L电压、Cornell电压、Cornell乘积、Lewis电压、Peguero电压及改良Cornell电压）及超声心动图结果进行评估。采用受试者工作特征（Receiver Operating Characteristic, ROC）曲线分析心电图对HCM的诊断价值，并通过多元线性回归探讨心电图指标与心脏舒张功能的相关性。
结果 Peguero电压对HCM的诊断灵敏度最高，达70.4%，特异度为88.6%。在男性患者（63.8%）、女性患者（84.9%）、年龄<65岁人群（71.6%）、年龄≥65岁人群（68.3%）、非心尖肥厚型心肌病（AHCM）患者（76.7%）、梗阻性HCM患者（82.1%）及非梗阻性HCM患者（66.9%）中，Peguero电压均表现出较高的诊断灵敏度。S-L电压对心尖肥厚型心肌病（Apical Hypertrophic Cardiomyopathy, AHCM）的诊断灵敏度较高，达72.2%。联合应用S-L电压与Peguero电压时，对HCM的诊断灵敏度可达88.7%。改良Cornell指数的曲线下面积最高，达0.88（95%置信区间：0.84~0.91）；其最优截断值在男性群体为2.05mV（灵敏度77.6%，特异度74%），在女性群体为1.935mV（灵敏度90.6%，特异度91.4%）。Peguero电压（β=0.154，P=0.034）与标准差（Standard Deviation, SD）（β=0.223，P=0.004）均与反映左心室舒张功能的E/e’指数独立相关。
结论 Peguero电压在检测肥厚型心肌病（HCM）时表现出较高的灵敏度与特异度，且在HCM患者中与E/e’呈正相关。针对心尖肥厚型心肌病（AHCM），S-L电压则更具诊断优势。联合应用S-L电压与Peguero电压可进一步提升HCM的诊断灵敏度，因此可用于优化临床实践中HCM的筛查流程。SD及改良Cornell电压同样具备良好的诊断效能，尤其在女性群体中表现突出。